Health Care Reform

Our nation’s health care system has entered a new era with the enactment of federal health care reform. This landmark legislation is resulting in many changes in how health care is financed and delivered for years to come. For nearly two decades, CHA has been at the forefront in advocating for meaningful health care reform — and we will continue to help shape the future of hospital care far into the future. CHA’s vision of an “optimally healthy society” is now a reality within reach.

This section provides materials to help hospitals understand and comply with the law, plan for the future, and communicate with their patients and communities about the impacts of health care reform.

Our nation’s health care system has entered a new era with the enactment of federal health care reform. This landmark legislation is resulting in many changes in how health care is financed and delivered for years to come. For nearly two decades, CHA has been at the forefront in advocating for meaningful health care reform — and we will continue to help shape the future of hospital care far into the future. CHA’s vision of an “optimally healthy society” is now a reality within reach.

This section provides materials to help hospitals understand and comply with the law, plan for the future, and communicate with their patients and communities about the impacts of health care reform.

Covered California has released a new analysis showing the consequences California faces if federal policies are changed – specifically, if funding for cost-sharing reduction reimbursements is ended and the individual shared responsibility payment is not enforced for consumers who choose not to purchase coverage. According to the report, Covered California’s premiums could rise 28 to 49 percent in 2018, and changes to federal policy could result in up to 340,000 consumers losing coverage. This would lead to increased federal spending, anticipated to be in the billions of dollars. More information is available in Covered California’s press release.

Last week, the Centers for Medicare & Medicaid Services (CMS) issued the Notice of Benefit and Payment Parameters final rule and the final Annual Letter to Issuers for 2018 in the Federally Facilitated Marketplaces. The final rule establishes standards for issuers and each health insurance marketplace, generally for plan years that begin on or after Jan. 1, 2018. The policies in the final rule include updates to the risk adjustment program and to eligibility, enrollment and benefits, as well as other changes that aim to streamline the marketplace consumer experience and strengthen the marketplaces’ individual and small group markets as a whole. The final rule builds on other actions CMS has taken to strengthen the marketplaces in recent weeks and months, including an interim final rule addressing concerns about third-party premium payments and a pilot that will test whether pre-enrollment verification of special enrollment periods strengthens the marketplace risk pool while maintaining access to coverage.

The California HealthCare Foundation has released a report that examines efforts to improve care quality, coordination and costs through provider collaborations. The report acknowledges that California providers — many of them CHA members — have been particularly active in developing collaborations among themselves and with commercial health plans in response to the Affordable Care Act. Many of these partnerships have been driven by key market factors characteristic of many California communities — most notably, the presence of large providers experienced in managing financial risk for patient care, as well as competitive pressure on both insurers and providers. Most of these initiatives aim to slow the growth of health care spending and improve the coordination and quality of patient care.

The report describes integration efforts that have proliferated in California since 2013, highlights leading examples from the seven regions studied, discusses collaborators’ key goals and strategies, and explores how market conditions spurred each major type of partnership and influenced their structure.

Working with colleagues in New York and New Hampshire, CHA asked members of the California congressional delegation to sign a letter addressed to Secretary of Health and Human Services Sylvia Burwell, urging reform of the current liver distribution methodology. A total of 68 members of the U.S. House of Representatives, including 27 from California, signed the letter.

The current methodology — which is based on 58 local donation service areas (DSAs) of varying size, density and health — creates large disparities in access to liver transplantation between patients in different regions of the country. To increase fairness of liver allocation, the signatories of the letter recommend that the Department of Health and Human Services adopt the United Network for Organ Sharing (UNOS) committee’s proposal to condense the 58 DSAs to between four and eight districts. The proposal also specifies that each district would contain at least six liver transplant centers that support a maximum median transplant-volume-weighted transport time between DSAs of no more than three hours. The letter echoes CHA’s beliefs, outlined in a comment letter to UNOS last week in support of their recommendations.

CHA has submitted the attached comment letter to the United Network for Organ Sharing (UNOS), supporting the Liver and Intestinal Organ Transplantation Committee’s recommendations to reduce geographic and economic disparities in access to liver transplantation. CHA believes the current liver allocation methodology, which operates under 58 local donation service areas (DSAs), is responsible for the unfair disparities that deprive many Californians of life-saving liver transplants.

In the letter, CHA comments on the high barriers Californians face in receiving liver transplantation compared with patients in other areas of the nation, who are arbitrarily favored due to the unbalanced structure of the 58 DSAs. In addition, because Californians suffer from a higher incidence of liver disease, patients wait longer, receive livers when they are sicker and die at substantially higher rates.

Hospitals can play an important role in reducing the number of uninsured through the Hospital Presumptive Eligibility (HPE) program. The HPE program will allow all hospital Medi-Cal providers — including any clinic on a hospital’s license — to provide potentially-eligible individuals with temporary, full-scope Medi-Cal benefits.

Overview

California has an estimated 7.1 million uninsured residents under age 65, the largest number of uninsured individuals of any state in the nation, representing over 21 percent of California’s population. Most of California’s uninsured residents (94 percent) will qualify for public or private health coverage under the Affordable Care Act (ACA). On January 1, 2014: